臺灣博碩士論文加值系統

唐氏症兒童中有很高比例有動作發展遲緩的問題，過去的研究顯示本體覺輸入(proprioceptive input)對於動作的控制與學習非常重要，但是操作本體覺輸入對於唐氏症兒童動作控制的影響仍有待探究。本研究希望探討本體覺輸入對於唐氏症兒童動作表現的影響，並比較與一般兒童之間的差異。本研究參與者包括唐氏症組四至七歲兒童18名(15名男生，3名女生)，年齡相當對照組兒童21人(14名男生，7名女生)。本研究係以分組因果比較研究設計，以重複量測的方式，讓所有參與者在三種本體覺情境下接受「布氏歐氏動作效能測試(簡版)」的評估，所有參與者也都接受「感覺史量表」的評估，以了解參與者感覺功能的狀況。研究結果顯示唐氏症兒童的動作表現顯著低於對照組兒童，依「布氏歐氏動作效能測試(簡版)」標準分數的評估結果，72.2%的唐氏症兒童屬於動作發展障礙。「感覺史量表」的評估結果顯示，唐氏症兒童在「感覺敏感」、「感覺登錄不良」、「分心」、「精細動作/視知覺」障礙與失調的比例顯著高於對照組，其中有「精細動作/視知覺」障礙的唐氏症兒童高達13人(72.2%)。相關分析也顯示這些感覺功能障礙與「跑步與敏捷性」、「平衡能力」、「兩側協調性」、「上肢協調性」、「視動控制能力」、「上肢速度與靈巧性」等向度的表現有顯著相關。對唐氏症組兒童來說，肢體附加重量會使動作表現下降，單側附加重量的情境下降的比例高於雙側附加重量的情境；對照組兒童在單側附加重量的情境下，動作表現則是有所增進。

Children with Down syndrome face difficulties in motor development. How to help these children develop their motor skills becomes research focus in early intervention. The previous research results showed proprioceptive input was very important to motor control, but how proprioceptive input influences motor performance of children with Down syndrome remain unclear. The purpose of this study was to investigate the influence of proprioceptive input on motor performance of children with Down syndrome. Repeated measure casual-comparative research design was employed in first stage of this research. One group of Down syndrome children age 4 to 7 (15 boys and 3 girls) and one group of typically developed children with chronological age matched (14 boys and 7 girls) participated in this study. Each participant received short form evaluation of Short form of Bruininks-Oseretsky Test of Motor Proficiency under three different proprioceptive input conditions to compare motor performance among three groups. Participants also received evaluation of Sensory Profile to reveal the relationship with motor performance. The results indicated motor performance of Down syndrome group was significantly lower than that of contorl group. Thirteen Down syndrome children (72.2%) were classified as disabled according to BOTMP-short evaluation result. The results of sensory profile revealed that Down syndrome children had sensory dysfunction in the domain of sensory sensitivity, poor registration, inattention and fine motor/visual percention domain. The sensory dysfunction was significant related to the performance in running speed and agility, balance, bilateral coordination, upper limb coordination, visual motor control, upper limb speed and dexterity of Down syndrome children. Unilateral increase weight over extremities input significantly decreased the motor performance of Down syndrome children but increased the motor performance of children in control group.

目 錄
中文摘要 I
英文摘要 II
目錄 IV
表次 VII
圖次 XI

第一章 緒論 1
第一節 研究背景與動機 1
第二節 研究問題與目的 7
第三節 研究假設 8
第四節 名詞解釋 9
第五節 研究範圍 11

第二章 文獻探討 12
第一節 唐氏症兒童的動作發展 12
第二節 感覺輸入對於動作的影響 19
第三節 兒童動作表現的評估 26
第四節 兒童感覺功能的評估 34

第三章 研究方法 38
第一節 研究流程 38
第二節 研究設計 41
第三節 研究參與者 42
第四節 評估方法與工具 44
第五節 評估人員訓練、評估情境與信度考驗 63
第六節 資料蒐集、分析與統計方法 65

第四章 研究結果 69
第一節 唐氏症組兒童與對照組兒童動作表現之比較 69
第二節 兒童感覺功能與動作表現之關係 89
第三節 不同本體覺輸入對於兒童動作表現之影響 105

第五章 討論 127
第一節 唐氏症組兒童的動作表現 127
第二節 兒童感覺功能與動作表現的關係 133
第三節 改變本體覺輸入對於動作表現之影響 137
第四節 唐氏症兒童動作評估的調整 140
第五節 研究限制 145

第六章 結論與建議 148
第一節 結論 148
第二節 建議 149

參考文獻 151
附錄一、研究參與者同意書 166
附錄二、感覺史量表樣本 169
附錄三、感覺史量表報告書樣本 175
附錄四、變項名稱對照表 176

表次
表2-1、動作技巧發展評估工具一覽表 33
表3-1、研究參與者基本資料表 42
表4-1、「布氏歐氏動作效能量表(簡表)」點數分數比較 70
表4-2、「布氏歐氏動作效能量表(簡表)」標準九分數比較 71
表4-3、唐氏症組兒童原始成績與點數分數皮爾遜相關係數分析 73
表4-4、對照組兒童原始成績與點數分數皮爾遜相關係數分析 74
表4-5、「兩腳交替踏步手指同時畫圓」組別間表現比較 77
表4-6、「感覺史量表」各向度原始分數結果摘要 89
表4-7、「尋求感覺刺激(SP1G)」組別間分類等級比較表 91
表4-8、「情緒反應(SP2G)」組別間分類等級比較表 92
表4-9、「感覺敏感(SP3G)」組別間分類等級比較表 93
表4-10、「感覺登錄不良 (SP4G)」組別間分類等級比較表 94
表4-11、「分心(SP5G)」組別間分類等級比較表 95
表4-12、「精細動作/視知覺(SP6G)」組別間分類等級比較表 96
表4-13、「觸覺防禦(SP7G)」組別間分類等級比較表 98
表4-14、「口腔敏感(SP8G)」組別間分類等級比較表 99
表4-15、唐氏症組動作原始成績與感覺史量表原始成績皮爾遜相關係數分析
-----------------------------------------100
表4-16、對照組動作原始成績與感覺史量表原始成績皮爾遜相關係數分析
-----------------------------------------101
表4-17、不同測試情境下兩組「布氏歐氏動作效能量表(簡表)」點數分數比較表 --------------------------------------------105
表4-18、「布氏歐氏動作效能量表(簡表)」點數分數重複量測變異數分析摘要 ----------------------------------------------106
表4-19、「布氏歐氏動作效能量表(簡表)」分類等級在不同測試情境比較
----------------------------------------------107
表4-20、不同測試情境下「跑步速度及敏捷性」原始成績比較--108
表4-21、「跑步速度及敏捷性」原始成績重複量測變異數分析摘要---108
表4-22、不同測試情境下「跑步速度及敏捷性」點數分數比較-------109
表4-23、「跑步速度及敏捷性」點數分數重複量測變異數分析摘要----109
表4-24、不同測試情境下「慣用腳單腳站立在平衡木上」原始成績比較--110
表4-25、「慣用腳單腳站立在平衡木上」原始成績重複量測變異數分析摘要
---------------------------------------------110
表4-26、不同測試情境下「慣用腳單腳站立在平衡木上」點數分數比較-111
表4-27、「慣用腳單腳站立在平衡木上」點數分數重複量測變異數分析摘要
---------------------------------------------111
表4-28、不同測試情境下「以腳尖腳跟方式向前走在平衡木上」步數比較
---------------------------------------------112
表4-29、不同測試情境下「兩腳交替踏步手指同時畫圓」原始成績比較--113
表4-30、不同測試情境下「雙腳跳起鼓掌」原始成績比較-----114
表4-31、不同測試情境下「雙腳跳遠」原始成績比較---------114
表4-32、「雙腳跳遠」原始成績重複量測變異數分析摘要------115
表4-33、不同測試情境下「雙腳跳遠」點數分數比較----------116
表4-34、「雙腳跳遠」點數分數重複量測變異數分析摘要------116
表4-35、不同測試情境下「雙手接球」原始成績比較----------118
表4-36、不同測試情境下「用慣用手丟球擊中目標」原始成績比較--119
表4-37、不同測試情境下「反應速度」原始成績比較----------120
表4-38、不同測試情境下「用慣用手畫直線通過平行的通道」點數分數比較
----------------------------------------------120
表4-39、不同測試情境下「用慣用手畫直線通過平行的通道」錯誤量比較
-----------------------------------------------121
表4-40、不同測試情境下「用慣用手複製畫一個圓圈」成績比較--122
表4-41、不同測試情境下「用慣用手複製畫重疊的鉛筆」成績比較--122
表4-42、不同測試情境下「用慣用手將紙牌分類」點數分數比較----123
表4-43、「用慣用手將紙牌分類」點數分數重複量測變異數分析摘要-123
表4-44、不同測試情境下「用慣用手將紙牌分類」張數比較--------124
表4-45、「用慣用手將紙牌分類」張數重複量測變異數分析摘要-----124
表4-46、不同測試情境下「用慣用手在圈圈內畫點」點數分數比較---125
表4-47、不同測試情境下「用慣用手將紙牌分類」張數比較--------126
表4-48、「用慣用手將紙牌分類」張數重複量測變異數分析摘要-----126
表5-1、兩組「布氏歐氏動作效能量表(簡表)」在不同情境動作表現排序比較
-------------------------------------------------139

圖次
圖3-1、研究步驟圖 40
圖3-2、「跑步速度及敏捷性」測試場地示意圖 49
圖3-3、「用慣用手畫直線通過平行的通道」測試圖樣 54
圖3-4、「用慣用手仿畫一個圓圈」測試圖樣 55
圖3-5、「用慣用手仿畫一個圓圈」評分標準圖樣 56
圖3-6、「用慣用手仿畫重疊的鉛筆」測試圖樣 56
圖3-7、「用慣用手仿畫重疊的鉛筆」評分圖樣 57
圖3-8、「用慣用手將紙牌分類」紙牌樣式 58
圖3-9、「用慣用手在圏圈內畫點」圖樣 60
圖4-1、「跑步速度及敏捷性」原始成績比較圖 72
圖4-2、「慣用腳單腳站立在平衡木上」原始成績比較圖 75
圖4-3、「腳尖腳跟走平衡木」原始成績比較圖 76
圖4-4、「雙腳跳起鼓掌」次數比較圖 78
圖4-5、「雙腳跳遠」距離比較圖 79
圖4-6、「雙手接球」次數比較圖 81
圖4-7、「用慣用手丟球擊中目標」次數比較圖 82
圖4-8、「用慣用手畫直線通過平行的通道」錯誤次數比較圖 83
圖4-9、「用慣用手複製畫一個圓圈」得分比較圖 84
圖4-10、「用慣用手複製畫重疊的鉛筆」得分比較圖 86
圖4-11、「用慣用手將紙牌分類」張數比較圖 87
圖4-12、「用慣用手在圈圈內畫點」點數比較圖 88
圖4-13、「尋求感覺刺激」組別間分類等級比較圖 90
圖4-14、「情緒反應」組別間分類等級比較圖 91
圖4-15、「感覺敏感」組別間分類等級比較圖 92
圖4-16、「感覺登錄不良」組別間分類等級比較圖 93
圖4-17、「分心」組別間分類等級比較圖 94
圖4-18、「精細動作/視知覺」組別間分類等級比較圖 96
圖4-19、「觸覺防禦」組別間分類等級比較圖 97
圖4-20、「口腔敏感」組別間分類等級比較圖 98
圖4-21、點數分數總分「組別」與「測試情境」交互作用圖 106
圖4-22、「雙腳跳遠」距離「組別」與「測試情境」交互作用圖 115
圖4-23、「雙腳跳遠」點數分數「組別」與「測試情境」交互作用圖 117

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